Strategies, Movements, and Progressions to Navigate Pelvic Girdle Pain — Part 2
By Kate Johnson @coach_katejohnson and Terri Robertson Elder @terri.elder.dpt
Strategies & Assessments | Calm It Down & Build It Up Programming | Movement Progressions & Regressions
As mentioned in Part 1, people experiencing pregnancy-related pelvic girdle pain (PR-PGP) are often told to avoid or stop doing certain movements or exercises, specifically unilateral (single-leg) movements. Other times people are told pelvic girdle pain is something they have to wait out, which can be frustrating and extremely unhelpful. Ultimately, we are not fragile and we have lots of options and opportunities — like working with pelvic health professionals and/or learning new strategies!
Moving our bodies, learning our current tendencies and adjusting to something different via strategies like breath and tension, and improving lumbo-pelvic control and strength can be helpful in managing pain and symptoms!
Identifying specific activities that seem to trigger pain or symptoms is a great place to start so that you can begin to adjust and adapt based on what you need. Below are strategies like breath, tension, position, and range of motion as areas of opportunity to explore. For each strategy, we want to assess our current tendencies so that we can then begin to test adjustments in our workouts and activities of daily living.
Strategies & Assessments
Breath
Good news! There is no wrong way to breathe! However, if we are experiencing pelvic girdle pain, dialing in some new and different breathing strategies can be a great starting place to explore.
Breathing Assessment |
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Step 1: Build awareness of how you breathe in various positions throughout the day.
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Step 2: Learn your tendency. On inhale where do you feel your breath going?
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Step 3: Test: On inhale, do your belly/ribs gently rise or do they contract inwards? |
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Step 4: Test: On exhale, do your belly and ribs contract or do they expand? Do your glutes clench? |
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Step 5: Test: When you laugh, cough, yell — what does your belly do? |
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Step 6: Test: Are you able to expand your ribs when you inhale? Imagine filling up balloons in your lungs. |
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Step 7: Test: Try a few squats or pick something off the floor. What do you notice? Did you hold your breath? Did you exhale at all? Inhale? |
Breathing Tips (for exercise)
Inhale:
As you inhale, think about a 360 degree breath, breathing right into the bra strap area around your ribcage, into your back, letting your belly gently rise.
Imagine broadening your pelvic floor or like it’s a flower opening (but we are not pushing down).
Exhale:
As you exhale, think about gently pursing your lips like you are blowing petals off a dandelion or blowing through a small straw.
As you exhale, your pelvic floor muscles will often automatically contract (sometimes this needs practice!). Imagine your vagina gently lifting a tissue out of a box or you are sipping up a milkshake through a straw. This should be gentle. *Note: see FYI below.
Next think about your hips bones gently coming together or lifting your belly button up and in towards your heart/sternum (not pulling belly button to spine) to add in coordinated transverse abdominals (deep corset muscles) for support. *Note: see FYI below.
Important: Try not to over contract — think about a level 3 not a level 10 on exhale and how hard you are contracting. Less is often more, with more not always being better. Think about using an appropriate “tension to task” to complete the task or movement. More challenging movements with higher loads may need more tension. (Tension to task concept from Antony Lo, Physiotherapist, https://physiodetective.com)
FYI: Sometimes we need to focus first on lengthening our pelvic floor muscles (often when there is pain), meaning the exhale with intentional contraction may not be an initial focus. We recommend working with a Pelvic Health Professional if you need further help assessing your individual considerations.
Check out two strategies below as great options to start with when first exploring breath during workouts and movements. You could also use these strategies during activities of daily living like lifting a car seat. Remember that these are only two suggestions. You are not breathing incorrectly if you do not apply one of these strategies nor do you need to utilize them for every workout or movement!
Option 1 Breath Strategy |
Option 2 Breath Strategy |
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Inhale 360 degrees (wide into ribs, back, let belly gently rise, let glutes relax), start a gentle exhale through full range of motion. Example: Inhale 360 degrees at the start position of the squat, then start to exhale as you initiate the squat descent. Continue to exhale through the full range of motion. Inhale, reset at the top of the squat. This strategy is common and one many athletes find themselves able to automate within workouts. Example Option 1 Breath Strategy for Squat |
Inhale 360 degrees (wide into ribs, back, let belly gently rise, let glutes relax) on the easy part of movement and start to gently exhale prior to the hard part of movement. Example: Inhale down on squat, gently start to exhale like you are blowing through a small straw right before you stand up out of squat. This strategy often works well for early postpartum, 3rd trimester, or those navigating pelvic health symptoms like pain. Example Option 1 Breath Strategy for Squat |
Tension
Tension is a good thing! It helps generate power into our lifts and aids us with our performance! We need tension; however, sometimes we use a little too much tension — not only in our workouts, but in our everyday life — by squeezing or holding in our glutes, abs, jaws, etc. More tension is not always better, and oftentimes dialing down tension and learning to spread tension around our body to match the task at hand can be extremely beneficial for any symptoms we have. It can improve performance too!
Build awareness of how you hold tension throughout the day and in various positions.
Ex: Do you squeeze everything as hard as possible before deadlifting?
Ex: When you are standing at the kitchen sink doing dishes, do you feel any tension in your glutes, abs, shoulders, jaw? Could you relax them (aka let them go)?
Tension Assessment |
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Step 1: Create max tension (global tension)… Squeeze everything in your body! |
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Step 2: Now relax! Pretend to melt! Channel Elsa and let it go, let it go more. Possible areas to feel yourself let go:
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Step 3: Assess. What do you feel? What feels good, best, or harder? |
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Step 4: Now try the tension strategy with a light deadlift or squat. What amount of tension feels best? Can you spread the tension around your body? Example Tension in the Squat |
Position/Posture
You’ve probably heard stories and biases about various postures — what is right and what is wrong, what is good and what is bad.
So what’s right?
It actually all depends. Our bodies enjoy variation. The demands of everyday life require us to be in a variety of positions throughout the day. Ultimately, there are no wrong or “bad” postures/positions to be in, however, there may be more effective ways that can help our body coordinate and feel better, especially if we have symptoms.
Build awareness of how you are positioned throughout the day.
Ex: Hold the baby only on one side?
Ex: Do the dishes with hips in front leaning on the counter?
Again, there is no wrong way — just the way that works best for you! Start building awareness to see what feels good or what could be done differently.
Position/Posture Assessment |
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Step 1: Take a picture of yourself in a mirror or have someone take a picture of you from the side.
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Step 2: Set a timer throughout the day (3-6 times) to check in on your position and adjust to something different to test how that may help improve symptoms! |
Position/Posture Tips
There is no one size fits all posture/position — neutral is a range for everyBODY.
Position strategies to explore could include:
Ribs over hips — check for ribs thrusting upwards focusing on keeping chest forward so if you had writing on your shirt, someone would be able to read it across the room.
Explore and play with rotation of the pelvis, such as tuck under and rotate pelvis out, and find a neutral position that works for you.
Relax your belly and your glutes.
If you feel pain in a certain position, please adjust!
During pregnancy note where your belly trajectory is pointing — if it’s pointing upwards, try adjusting so that it’s more forward or even down sometimes.
Range of Motion/Adjusting Movement
There is so much opportunity to find and utilize movements that can help support us as we navigate and begin to manage PGP. Use this time to explore and customize movements as needed.
Adjust Depth
Example: Try adding a box for a higher target during squats. If you feel pain during a full range of motion squat, try adjusting the depth and only squat to right before you start to feel discomfort.
Adjust Stance
Example: Unilateral movements like lunges can be great during pregnancy! However, if you are experiencing pain, you may have been told to avoid them. Oftentimes adjusting to a split squat can help mitigate pain and symptoms (and often in conjunction with these other strategies).
Example: Squatting, Lunging, or Deadlifting with a narrower stance may help manage pain. Everyone will be individual as to how close or wide.
Example: Single leg deadlifts can be adjusted to a kickstand variation for increased support and stability.
Adding Support
Example: Hold onto a rig, wall, or chair while performing movements like squats, lunges, or step ups to help decrease load and increase stability.
Adding Rotation: Add rotation during unilateral movements.
Example: During a lunge, try rotating towards the front leg.
Adjust and Adapt
Utilize core and pelvic health strategies to work with you for longterm function and strength.
Adjust load, volume, stimulus, range of motion, readiness for a movement based on risk vs. reward or reasoning for doing the movement.
As symptoms improve, you can start to progressively build forward, gradually doing more over time (walk before run, squat before jump). If symptoms flare, adjust starting first with some of these strategies and movements!
Programming Movements to Help Manage PGP
Now that we have reviewed possible strategies, what movements should we start incorporating to help manage PGP? Do we start with “Calm It Down” or “Build It Up”?
As referenced in Part 1, “Calm It Down” and “Build It Up” are not necessarily two distinct phases. If your pain is mild, you may focus on more from the “Build It Up” category, whereas if your pain is more moderate, you may focus more on the “Calm It Down” and work towards the “Build It Up” options as you are able. If your pain is severe, please consider seeing a professional for individualized guidance and support. We suggest choosing a few movements to explore as a movement snack during the day, as a part of a warm-up or cool-down, or with some of the “Build It Up” options as a focused PGP session. You might spend 30 seconds to a minute (or longer if it feels good!) exploring each stretch or movement and then switch sides.
The suggested movements are not an exhaustive list and should not be taken as medical advice. We recommend working with a Pelvic Health Professional for an assessment and individualized plan when possible.
Example Relaxation & Mobility Moves — Calm It Down
Diaphragmatic Breathing (ex: feet up on wall/couch or quadruped position)
Elevated Figure 4 or reclined figure 4
Programming Suggestions
1-3 times per day [before or after workout, midday, before bed] depending on time available and how these movements feel for you
2-5 minute sessions or as time allows
Choose 1-3 movements that you feel make a positive impact
Calm It Down Programming Examples PDF
Strengthen — “Build It Up”
As pain subsides, adding in movements that help “Build It Up” — or strengthen, coordinate, and build resilience to our pelvic region — can be beneficial in helping manage symptoms! Look to add in movements in all three planes of motion, as well as utilizing anti-rotation, rotation, flexion, anti-flexion, unilateral, ADDuction, and ABduction movements to help build strength and improve coordination between muscles.
This is not an exhaustive list of movements and are being provided with the intention of how to proceed with limited equipment. If pain for any movement is higher than a 3 or 4 out of 10, pause the movement and adjust to a new strategy (see above) and work with a Pelvic Health Professional as needed. (This is not medical advice.)
Example Strengthen or Build It Up Movements
Banded Lateral Walk (degrees of band placement)
Bird Dog (arms only, legs only, arms and legs)
Programming Suggestions
2-3 times per week (before Daily Workout OR stand alone)
10-15 minute sessions depending on time availability
Choose 2-3 movements
Extra equipment possibly needed: mini bands, yoga block or pilates ball (a small kids ball works well too!)
Regression/Progression of Movement Examples
Listed below are common movements in our Street Parking Daily Workouts. We often receive questions on how to adjust and adapt due to pelvic pain with these movements.
Utilize the progressions/regressions as another tool to adjust and adapt. Everyone will be different regarding what may work best for their individual considerations. Ultimately, we want to meet you where you are to find what works best for you right now to help build you forward.
Customize workouts, utilizing fitness freedom to help you continue to keep moving in a way that supports you now and over the long term!
Regression/Progressions of Common Movements
Reminder! You can further adjust and apply breathing, tension, position, and other movement strategies for these movements.
Squat — Squat with load, Squat, Box Squat with Reduced ROM, Supported Squat
Lunge — Walking Lunge, Forward Lunge, Reverse Lunge, Split Squat, Reduced ROM, Supported Split Squat
Step Up — Loaded Step Up, Stepup, Static Step Up, Reduced Height Step Up, Lateral Step Up, Supported Step Up
Walking — Strategies discussed include position, cadence, tension, and breath
Deadlift — Deadlift (adjust load), Deadlift (adjust stance), Deadlift (adjust position of load via barbell, KB, DB, hex bar, etc.), Elevate Deadlift to reduce ROM, Good Morning, Glute Bridge, Kneeling Hinge
Our goal is to provide you with strategies to ease your symptoms and to stay as active as possible across your pregnancy and postpartum journey, but as always, the information provided is not a substitute for medical advice. If your pain is significantly impacting you, please speak to a provider such as your OB/Midwife and/or a pelvic health physical or occupational therapist if you are able to access care. If you need support with your workouts, please reach out to mamas@streetparking.com.